Increased energy needs in patients with quadriplegia and pressure ulcers

Health individuals with quadriplegia generally have a reduced metabolic rate. However, individuals with quadriplegia who develop pressure ulcers may have an elevated metabolic rate. In this study, energy expenditure in 16 individuals with quadriplegia and pressure ulcers (PU-QUAD) was compared to the energy expenditure in 16 individuals with quadriplegia but no pressure ulcers (NPU-QUAD) and 16 healthy non-spinal cord injured subjects (controls). Resting energy expenditure (REE) was measured by indirect calorimetry. Both measured REE (t(30) = 2.38, p = 0.24) and percent predicted REE (t(30) = 3.23, p = .003) were significantly higher in subjects with quadriplegia and pressure ulcers compared with subjects with quadriplegia but no pressure ulcers. On average, REE in the PU-QUAD subjects was nearly equal to the absolute energy expenditure of healthy non-spinal cord injured controls. To ensure optimal care of patients with quadriplegia and pressure ulcers, quantification of energy expenditure with provision of adequate caloric intake is recommended.